Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Windsor Clinical Research, Windsor, ON, Canada.
Skin Therapy Lett. 2021 Jul;26(4):1-8.
The diagnosis and classification of rosacea has been modified to reflect presenting features. On exclusion of differentials, the diagnosis of rosacea is based on the presence of either (1) phymatous changes, or (2) centrofacial persistent erythema. In their absence, diagnosis can be established by presence of any two of: flushing/transient erythema, papules and pustules, telangiectases, or ocular manifestations. Management of rosacea depends on presenting feature(s), their severity, and impact. General management includes gentle skin care, sun protection, and trigger avoidance. Evidence-based treatment recommendations include topical brimonidine and oxymetazoline for persistent erythema; topical azelaic acid, ivermectin, metronidazole, minocycline and oral doxycycline, tetracycline and isotretinoin for papules and pustules; vascular lasers and light devices for telangiectases; and omega-3 fatty acids and cyclosporine ophthalmic emulsion for ocular rosacea. While surgical or laser therapy can be considered for clinically noninflamed phyma, there are no trials on their utility. Combination therapies include topical brimonidine with topical ivermectin, or topical metronidazole with oral doxycycline. Topical metronidazole, topical ivermectin, and topical azelaic acid are appropriate for maintenance therapy. In conclusion, the updated phenotype approach, based on presenting clinical features, is the foundation for current diagnosis, classification, and treatment of rosacea.
酒渣鼻的诊断和分类已经修改，以反映其表现特征。在排除其他鉴别诊断后，酒渣鼻的诊断基于以下两种情况之一：（1） 永久性鼻肿，或（2） 中心面部持续性红斑。如果不存在这些情况，则可以通过以下两种或两种以上的表现来确立诊断：潮红/短暂性红斑、丘疹脓疱、毛细血管扩张或眼部表现。酒渣鼻的治疗取决于表现特征、严重程度和影响。一般管理包括温和的皮肤护理、防晒和避免触发因素。基于证据的治疗建议包括：持续红斑用局部布美他尼和羟甲唑啉；丘疹脓疱用局部壬二酸、伊维菌素、甲硝唑、米诺环素和口服多西环素、四环素和异维 A 酸；毛细血管扩张用血管激光和光设备；眼部酒渣鼻用欧米伽-3 脂肪酸和环孢素眼用乳液。虽然可以考虑手术或激光治疗非炎症性的临床永久性鼻肿，但目前还没有关于其疗效的试验。联合治疗包括局部布美他尼联合局部伊维菌素，或局部甲硝唑联合口服多西环素。局部甲硝唑、局部伊维菌素和局部壬二酸适用于维持治疗。总之，基于当前表现临床特征的更新表型方法是酒渣鼻当前诊断、分类和治疗的基础。
